Growth, Body Composition, and Micronutrient Abnormalities During and After Weaning Off Home Parenteral Nutrition

Neelis, Esther; Olieman, Joanne; Rizopoulos, Dimitris; Wijnen, René; Rings, Edmond H. H. M.; Koning, Barbara de; Hulst, Jessie M.

doi:10.1097/mpg.0000000000002090

Cited by 20 publications

(19 citation statements)

References 26 publications

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“…Regardless of type of IF and PN dependency, all patients in our study had significantly low FFMI. Low FFM has also been described in previous studies in which most or all children were already weaned off PN . In another study using dual‐energy X‐ray absorptiometry (DEXA) scans, patients had significantly low limb lean mass, especially patients with short bowel syndrome .…”

Section: Discussionsupporting

confidence: 61%

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Body Composition Using Air Displacement Plethysmography in Children With Intestinal Failure Receiving Long‐Term Home Parenteral Nutrition

Neelis

Kouwenhoven

Olieman

et al. 2019

J Parenter Enteral Nutr

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Background Children with intestinal failure (IF) are at risk of growth failure, but little information about body composition is available. Our aim was to assess body composition using air displacement plethysmography (ADP) and relate it to clinical and growth parameters. Methods In this prospective descriptive observational 2‐center cohort study, children aged 2–18 years receiving home parenteral nutrition (PN) for ≥6 months underwent ADP measurement. Fat mass index (FMI) and fat‐free mass index (FFMI) standard deviation scores (SDSs) were calculated to normalize for small body size. Results Twenty‐one out of 22 children, median age 7.4 years, underwent successful ADP measurement after a median PN duration of 5.5 years. They were significantly lighter (median weight for age SDS −0.71, P = 0.004) and shorter (median height for age SDS −1.55, P < 0.001) than the normal population mean; 52% were growing below target height range. They had low FFMI (median SDS −1.53, P < 0.001) and high FMI (median SDS 0.80, P = 0.002). Weight for height and body mass index (BMI) were significantly associated with FFMI and BMI with FMI, but children with the same weight and height showed different body composition. In 13 patients with 1‐year follow‐up, growth and body composition did not change significantly. Conclusion Children with IF receiving long‐term PN show lower FFM and higher FM than healthy children. Additionally, children with similar routine growth parameters showed different body composition. Further studies should evaluate the effect of a patient‐tailored approach including physical activity and nutrition advice based on body composition.

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Section: Discussionsupporting

confidence: 61%

“…Low FFM has also been described in previous studies in which most or all children were already weaned off PN. 2,33 In another study using dual-energy X-ray absorptiometry (DEXA) scans, patients had significantly low limb lean mass, especially patients with short bowel syndrome. 3 In addition to low FFM, patients had significantly high FMI.…”

Section: Discussionmentioning

confidence: 99%

Body Composition Using Air Displacement Plethysmography in Children With Intestinal Failure Receiving Long‐Term Home Parenteral Nutrition

Neelis

Kouwenhoven

Olieman

et al. 2019

J Parenter Enteral Nutr

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“…This nutrition assessment should incorporate aspects influencing intake, absorption, and expenditure, such as sex and age, the anatomy of the intestine (i.e., remaining bowel length, enterostomies, presence of ileocecal valve), and weight, height, and body composition. For visual representation see Figure 1, a more detailed description of the individual components is provided in Table 2 [14][15][16][17][18][19][20][21][22][23][24][25]. The assessment should be repeated regularly to evaluate the effectiveness of a nutrition intervention and to prevent patients from becoming dehydrated and undernourished with associated electrolyte abnormalities and weight loss.…”

Section: General Management Of Intestinal Failure Patientsmentioning

confidence: 99%

“…Micronutrient deficiencies are common in IF patients [18,19]. Electrolytes such as sodium and magnesium may be low due to excessive gastrointestinal losses, whereas calcium, phosphate and potassium can be elevated as a consequence of dehydration [20].…”

Section: Biochemistry: Electrolytes and Micronutrientsmentioning

confidence: 99%

The Role of a Nutrition Support Team in the Management of Intestinal Failure Patients

et al. 2020

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Parenteral nutrition (PN) is a complex and specialized form of nutrition support that has revolutionized the care for both pediatric and adult patients with acute and chronic intestinal failure (IF). This has led to the development of multidisciplinary teams focused on the management of patients receiving PN: nutrition support teams (NSTs). In this review we aim to discuss the historical aspects of IF management and NST development, and the practice, composition, and effectiveness of multidisciplinary care by NSTs in patients with IF. We also discuss the experience of two IF centers as an example of contemporary NSTs at work. An NST usually consists of at least a physician, nurse, dietitian, and pharmacist. Multidisciplinary care by an NST leads to fewer complications including infection and electrolyte disturbances, and better survival for patients receiving short- and long-term PN. Furthermore, it leads to a decrease in inappropriate prescriptions of short-term PN leading to significant cost reduction. Complex care for patients receiving PN necessitates close collaboration between team members and NSTs from other centers to optimize safety and effectiveness of PN use.

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“…Therefore, monitoring vitamin and mineral status is recommended in these patients [13,14]. Neelis et al found low blood values of vitamin A in 90%, zinc in 87%, and iron in 76% of IF children on HPN [15]. Other studies have indicated that supplying iodine and iron may be challenging [16e20].…”

Section: Introductionmentioning

confidence: 99%

Micronutrients in paediatric Intestinal Failure Patients receiving home parenteral nutrition

et al. 2020

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Background & aims: Children with intestinal failure (IF) receive parental nutrition to ensure adequate growth and development. The aim of this study was to assess micronutrient status in paediatric IF patients receiving home parenteral nutrition (HPN) in comparison to a group of healthy children. Methods: An observational cross-sectional study was performed at Oslo University Hospital and at the Department of Nutrition, University of Oslo from January to September 2017. All children with IF, aged two to 18 years, were invited to participate. A reference group of healthy children was recruited through social media advertisement. Dietary intake was assessed by a four-day food record, and enteral and parenteral provision was recorded. Blood samples were analysed for vitamins, minerals and haematology to assess iron status. Two spot urine samples from each subject were analysed for iodine concentration (UIC) and creatinine. Results: Nineteen children with IF and 50 healthy children were included. The mean age of the participants was 10.0 years. IF-patients received a median of 76% of their estimated energy requirements from parenteral nutrition (PN). Recommended intake (RI) for iodine from the diet was reached by 16% of IF patients and 28% of healthy children. In the IF group there was a significant positive correlation between UIC and the percentage of iodine intake from oral diet and enteral nutrition support (r ¼ 0.57, p ¼ 0.03). Although the IF patients had a median parenteral iodine supply of more than twice the ESPGHAN recommendation, the median UIC was 89 mg/L indicating insufficient iodine status. This may suggest that the ESPGHAN recommendation for iodine in paediatric parenteral nutrition is too low. The healthy children had sufficient iodine status according to the median UIC (133 mg/L). IF patients had significantly lower total provision of iron compared to the healthy children, 4,9 vs 8,4 mg/day (p ¼ 0.01) with 21% of IF patients and 28% of healthy children reaching RI for iron. The prevalence of anaemia was higher in IF patients than in the healthy children (40 vs.10%, p ¼ 0.016). Conclusion:The study indicates an insufficient iodine and iron status among paediatric IF patients. Iodine status was associated with enteral provision and patients had insufficient status even if they received the ESPGHAN recommendation of iodine.

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Growth, Body Composition, and Micronutrient Abnormalities During and After Weaning Off Home Parenteral Nutrition

Cited by 20 publications

References 26 publications

Body Composition Using Air Displacement Plethysmography in Children With Intestinal Failure Receiving Long‐Term Home Parenteral Nutrition

Body Composition Using Air Displacement Plethysmography in Children With Intestinal Failure Receiving Long‐Term Home Parenteral Nutrition

The Role of a Nutrition Support Team in the Management of Intestinal Failure Patients

Micronutrients in paediatric Intestinal Failure Patients receiving home parenteral nutrition

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